2020 年第 7 期 第 15 卷

血浆Presepsin在小儿脓毒症早期诊断及预后评估中的临床应用

he clinical application of plasma Presepsin in early diagnosis and prognosis of sepsis in children

作者：朱孟沙1张贵英1赵清娟1郝京霞2李博2张英谦2

英文作者：Zhu Mengsha1 Zhang Guiying1 Zhao Qingjuan1 Hao Jingxia2 Li Bo2 Zhang Yingqian2

单位：1河北省儿童医院重症医学二科，石家庄050031；2河北省儿童医院心内科，石家庄050031

英文单位：1Second Department of Critical Care Medicine Hebei Children′s Hospital Shijiazhuang 050031 China； 2Department of Cardiology Hebei Children′s Hospital Shijiazhuang 050031 China

关键词：脓毒症；血浆Presepsin；早期诊断；预后

英文关键词：Sepsis；PlasmaPresepsin；Earlydiagnosis；Prognosis 

• 摘要：

• 目的研究血浆Presepsin在小儿脓毒症早期诊断和预后评估中的应用价值。方法选取2017年1月至2019年1月河北省儿童医院30例体检健康儿童（A组）、45例全身炎症反应综合征患儿（B组）及45例脓毒症患儿（C组）。比较3组儿童血浆Presepsin、降钙素原及C反应蛋白（CRP）水平。根据病情严重程度将脓毒症患儿分为脓毒症组（25例）和脓毒症休克组（20例）。记录脓毒症患儿28 d病死率，采用受试者工作曲线（ROC）分析血浆Presepsin、降钙素原及CRP在早期诊断脓毒症和预后评估中的价值。结果C组血浆Presepsin、降钙素原及CRP水平均明显高于A、B组［（940±371）ng/L比（39±19）、（47±20）ng/L，（49.8±13.4）μg/L比（1.0±0.5）、（34.2±9.7）μg/L，（62.8±20.4）mg/L比（7.6±2.2）、（58.4±15.5）mg/L］，差异均有统计学意义（均P＜0.05）。脓毒症组患儿血浆Presepsin、降钙素原及CRP水平均明显低于脓毒症休克患儿，差异均有统计学意义（均P＜0.05）。血浆Presepsin早期诊断脓毒症患儿的曲线下面积（AUC）明显大于降钙素原和CRP(0.916比0.817、0.766)，差异均有统计学意义（均P＜0.05）。45例脓毒症患儿入院28 d后12例死亡，病死率为26.7%。血浆Presepsin评估脓毒症患儿预后的AUC明显大于降钙素原和CRP(0.812比0.657、0.542)，差异均有统计学意义（均P＜0.05）。结论血浆Presepsin早期诊断小儿脓毒症的准确性高于降钙素原和CRP，有助于脓毒症患儿预后的评估。

• ObjectiveTo evaluate the application value of plasma Presepsin in early diagnosis and prognosis of sepsis children. Methods Thirty healthy children (group A), 45 children with systemic inflammatory response syndrome (SIRS)(group B) and 45 children with sepsis (group C) admitted to Hebei Children′s Hospital from January 2017 to January 2019 were selected. Presepsin, procalcitonin (PCT) and C-reactive protein (CRP) levels in three groups of children were compared. The children with sepsis were divided into sepsis group (25 cases) and septic shock group (20 cases). The prognosis of children with sepsis was recorded； the value of plasma Presepsin, PCT and CRP in early diagnosis and prognosis evaluation was analyzed by receiver operating curve (ROC). Results  The plasma Presepsin, PCT and CRP in group C were significantly higher than those in group A and B［（940±371）ng/L vs （39±19）,（47±20）ng/L；（49.8±13.4）μg/L vs （1.0±0.5）,（34.2±9.7）μg/L；（62.8±20.4）mg/L vs （7.6±2.2）,（58.4±15.5）mg/L］(all P＜0.05). The plasma Presepsin, PCT and CRP in sepsis children were significantly lower than those in sepsis shock children (all P＜0.05). There were 12 deaths and the mortality rate was 26.7%. The area under curve (AUC) of plasma presepsin in early diagnosis of sepsis in children was significantly higher than that of PCT and CRP (0.916 vs 0.817, 0.766； P＜0.05). The AUC of plasma presepsin with prognosis was significantly higher than that of PCT and CRP (0.812 vs 0.657, 0.542； P＜0.05). Conclusion The accuracy of plasma Presepsin in early diagnosis of sepsis is higher than that of PCT and CRP； it can be used to evaluate the prognosis of children with sepsis.